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Does lowering the reading level of a health education pamphlet actually increase the comprehension by adult readers for whom English is a second language? We lowered the reading level of a general pharmacy education handout by changing vocabulary, sentence structure, and organization; by highlighting the main idea of each point; and by writing an introduction designed to catch attention and focus reading. Low-intermediate and advanced English as a Second Language (ESL) college students read either the unaltered (24 students) or altered (25 students) version of the pamphlet, which were estimated to be at the grade 12 and grade 7 level respectively according to the Flesch-Kincaid readability formula. Subjects then answered a free written test and a short-answer test. There was no statistically significant difference in the reading comprehension scores of the two groups on the free written test (p=0.14) or on the short-answer test (p=0.59). Health educators and ESL professionals should be wary of using readability formulas to estimate the suitability of materials for ESL readers, and of assuming that lowering the reading level of materials means increasing comprehension even when some changes beyond the lexical and syntactical are made.

Effect of Lowering the Reading Level of a Health Education Pamphlet on Increasing Comprehension by ESL Students